Abstract
BackgroundAt present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS?MethodsThis retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.ResultsAll 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 min. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P = 0.00), 2.47 (P = 0.71), and 19.40% (P = 0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28 ± 13.08 mm2 vs.104.91 ± 12.40 mm2, P = 0.00).ConclusionsExcept for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.
Highlights
At present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS)
Minimally invasive surgery (MIS) represented by micro-endoscopic decompression (MED) has achieved good clinical results in the treatment of CLSS, and some studies have revealed that these minimally invasive surgery (MIS) techniques have obvious advantages over traditional laminectomy [11, 13]
Thirty-eight patients were complicated with hypertension (24 cases), coronary heart disease (9 cases), diabetes (12 cases), chronic obstructive pulmonary disease (11 cases), arrhythmias (3 cases), heart failure (4 cases), and other medical disorders (8 cases)
Summary
Few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Central lumbar spinal stenosis (CLSS) is a progressive degenerative disease, most commonly in patients over 60 years. Conventional laminectomy provides adequate decompression by removing posterior structures including lamina, spinous processes, interspinous ligaments, ligamentum flavum and part of the facet joints [10]. This method has the disadvantages of chronic low back pain and iatrogenic instability and sometimes requires a second operation [11, 12]. Minimally invasive surgery (MIS) represented by micro-endoscopic decompression (MED) has achieved good clinical results in the treatment of CLSS, and some studies have revealed that these MIS techniques have obvious advantages over traditional laminectomy [11, 13]
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